A preliminary study on the neurocognitive deficits associated with loneliness in young adults.

The experience of loneliness is universal and may have an adverse effect on neurocognitive functioning even at a younger age. Using a comprehensive neurocognitive functioning test (NCFT) battery, we examined the possible negative effects of loneliness on neurocognitive functioning in young adults. The high-loneliness and low-loneliness groups were screened using the UCLA Loneliness Scale v. 3, and measures pertaining to the domains of intelligence, attention, memory, executive function, and psychomotor functioning were tested and compared. As depression and anxiety were significantly higher in the high-loneliness group, an analysis of covariance was conducted. As a result, the high-loneliness group showed significantly poor performance on measures of executive function and attention prior to controlling for depression and anxiety, and executive function retained its significance even after controlling for these variables. Additional analysis showed that depression and anxiety did not significantly mediate the relationship between loneliness and neurocognitive functioning. Such results suggest that loneliness is likely to negatively affect executive functioning and attention in early adulthood and then progressively spread to other domains of cognitive functioning, as reported in the older adult population. The limitations and implications of the present study were considered and addressed.

Food Addiction and Emotional Eating Behaviors Co-Occurring with Problematic Smartphone Use in Adolescents?

Addiction in adolescence is increasing and has a significant impact on physical and mental health. Notably, addictions can be comorbid and affect each other. Despite the recent growing interest in food addiction (FA) and problematic smartphone use (PSU), few studies have investigated their association in adolescents. We investigated the relationship between FA and PSU in adolescents and the effects of eating behaviors. A total of 209 adolescents (44.5% male; mean age = 12.86 ± 0.7 years) participated in the current school-based community study. We found a positive correlation between the dimensional Yale Food Addiction Scale for Children 2.0 (dYFAS-C2.0) and the Smartphone Overdependence Scale after adjusting for age, sex, body mass index, and socioeconomic status. The high-risk PSU group accounted for 17.2% of participants. Furthermore, this group showed 2.3 times higher dYFAS-C2.0 scores than the general group. Emotional overeating and satiety responsiveness were correlated with PSU. A comprehensive evaluation of addiction symptoms is needed for proper intervention, especially in adolescents with symptoms of abnormal eating behaviors.

Validity and Reliability of Korean Version of Behavior Problems Inventory in Autism Spectrum Disorder and/or Intellectual Developmental Disorder.

OBJECTIVES: Problem behaviors pose a great obstacle to daily functioning in children with neurodevelopmental deficits and are an important target for treatment. In this study, we translated the Behavior Problems Inventory (BPI)-01 into Korean language and tested its psychometric properties. METHODS: We attained the approval of the BPI author and performed standard translation-back translation. Then, professional caregivers examined appropriateness according to cultural and situational contexts in order to make necessary modifications of the Korean version of the BPI. RESULTS: The BPI-01, Korea-Scales of Independent Behavior-Revised (K-SIB-R), and Child Behavior Checklist were completed for 98 autistic spectrum disorder or intellectual development disorder participants (mean age=28.3, standard deviation=7.3, range=10.1-51.7). The inter-rater reliability of the BPI-01 was found to be high (r=0.992-1.000). As for the results for concurrent validity for subscale items of BPI-01 and scales of SIB, correlations between SIB and BPI-01 subscales were statistically significant (r=0.357-0.672). DISCUSSION: The Korean version of the BPI-01 showed good psychometric properties with high reliability and sufficient convergent validity. Further examination of the validity of BPI-01 should be carried out with inclusion of younger aged children and a closer look at less frequently occurring symptoms.

The longitudinal trends in the relationship between drug-induced extrapyramidal symptoms and personal and social performance in a population of the patients with schizophrenia: A latent growth model.

The aim of this study was to explore the longitudinal trends in the relationship between personal and social functioning and drug-induced extrapyramidal symptoms (DIEPS). The baseline sample included 484 patients with schizophrenia. Participants were assessed at baseline, weeks 4 (time 2), 8 (time 3), and 12 (time 4) regarding social functioning, and DIEPS. In latent growth analysis, the path coefficient between the intercept for the DIEPSS and the intercept for the PSP indicated a significant cross-sectional relationship between these two variables. And the path coefficient between the intercept of the DIEPSS and the slope of the PSP was also significant, indicating that patients who initially had more serious side effects tended to exhibit less improvement in their personal and social functioning over time. Similarly, a significant path coefficient between the slopes of the two variables indicated a dynamic and possibly reciprocal association over time. In addition, K-PSP scale showed good construct validity and reliability. Based on the standardized PSP scale, our results demonstrate DIEPSS induced by antipsychotic treatment dynamically affect personal and social functioning over time, a negative association between psychosocial aspects and the DIEPS.

Characteristics and Psychiatric Symptoms of Internet Gaming Disorder among Adults Using Self-Reported DSM-5 Criteria.

OBJECTIVE: The Section III of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) proposed nine diagnostic criteria and five cut-point criteria for Internet Gaming Disorder (IGD). We aimed to examine the efficacy of such criteria. METHODS: Adults (n=3041, men: 1824, women: 1217) who engaged in internet gaming within last 6 months completed a self-report online survey using the suggested wordings of the criteria in DSM-5. Major characteristics, gaming behavior, and psychiatric symptoms of IGD were analyzed using ANOVA, chi-square, and correlation analyses. RESULTS: The sociodemographic variables were not statistically significant between the healthy controls and the risk group. Among the participants, 419 (13.8%) were identified and labeled as the IGD risk group. The IGD risk group scored significantly higher on all motivation subscales (p<0.001). The IGD risk group showed significantly higher scores than healthy controls in all nine psychiatric symptom dimensions, i.e., somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism (p<0.001). CONCLUSION: The IGD risk group showed differential psychopathological manifestations according to DSM-5 IGD diagnostic criteria. Further studies are needed to evaluate the reliability and validity of the specific criteria, especially for developing screening instruments.

Neurocognitive functioning as an intermediary variable between psychopathology and insight in schizophrenia.

Based on the neuropsychological deficit model of insight in schizophrenia, we constructed exploratory prediction models for insight, designating neurocognitive measures as the intermediary variables between psychopathology and insight into patients with schizophrenia. The models included the positive, negative, and autistic preoccupation symptoms as primary predictors, and activation symptoms as an intermediary variable for insight. Fifty-six Korean patients, in the acute stage of schizophrenia, completed the Positive and Negative Syndrome Scale, as well as a comprehensive neurocognitive battery of tests at the baseline, 8-weeks, and 1-year follow-ups. Among the neurocognitive measures, the Korean Wechsler Adult Intelligence Scale (K-WAIS) picture arrangement, Controlled Oral Word Association Test (COWAT) perseverative response, and the Continuous Performance Test (CPT) standard error of reaction time showed significant correlations with the symptoms and the insight. When these measures were fitted into the model as intermediaries between the symptoms and the insight, only the perseverative response was found to have a partial mediating effect - both cross-sectionally, and in the 8-week longitudinal change. Overall, the relationship between insight and neurocognitive functioning measures was found to be selective and weak.

Refinement of the SWN-20 based on the Rasch rating model.

OBJECTIVES: The aim of the present study was to refine the 20-item Subjective Well-Being under Neuroleptic Treatment Scale (SWN-20) using the Rasch rating model to validate measurements of subjective well-being in patients with schizophrenia undergoing antipsychotic treatment. METHODS: In total, 854 (403 males, 451 females) inpatients (n=213) and outpatients (n=641) with schizophrenia participated in this study, which was designed as an open-label investigation of paliperidone extended release. The participants completed the Korean version of the SWN-20 themselves. Refinement of the Korean version of the SWN-20 was accomplished using the Rasch rating model. RESULTS: Infit and outfit statistics for all 20 items satisfied the criterion for construct validity. Second, all items except items 2 and 20 had suitable point-measure correlations, reflecting content validity. Third, item characteristic curves indicated that roughly 18 items were evenly distributed along the person ability continuum. Finally, option analysis of the category characteristics showed that categories 3 and 4 in the SWN-20 response format were unnecessary. CONCLUSIONS: We offer several recommendations for improving the SWN-20: (a) items 2 and 20 should be omitted to ensure construct validity; (b) easier items would be added related to the person ability estimates in the process of validating a short form of the SWN scale based on item response theory; and (c) the number of response categories should be reduced for schizophrenic patients.

Evaluating subjective domains of antipsychotic-induced adverse effects using heart rate variability.

AIMS: Antipsychotic-induced autonomic dysregulation may lead to a wide range of subjective side-effects in schizophrenia patients. Using heart rate variability (HRV) measures, we prospectively examined the relationship between subjective side-effects and cardiac autonomic regulation in unmedicated schizophrenia patients. METHODS: Forty-five unmedicated schizophrenia patients were assessed for antipsychotic-associated side-effects and HRV parameters at baseline and after 6 weeks of treatment. Psychiatric symptoms and subjective side-effects were assessed using the Positive and Negative Syndrome Scale (PANSS) and the Liverpool University Neuroleptic Side-effect Rating Scale (LUNSERS). RESULTS: Correlations between subjective adverse effects and HRV measures at baseline and at week 6 varied. Nonetheless, the changes in the psychic side-effects domain were significantly correlated with the changes in time-domain HRV measures and sample entropy (SampEn). In addition, the change in SampEn was significantly associated with that in the scores of extrapyramidal, anticholinergic, miscellaneous, and red herring domains as well as the mean total LUNSERS score. CONCLUSION: Baseline HRV measures may predict clinical response and adverse events associated with treatment adherence. Also, subjective side-effects may correspond well with the changes in neurocardiac dynamics, and the changes in SampEn may effectively reflect subjective discomfort in patients receiving antipsychotic treatment.

Examination of categorical approach to symptom assessment: cross-validation of foulds' Delusions-Symptoms-States Inventory with Korean non-patient and patient groups.

BACKGROUND: Foulds' Delusions-Symptoms-State Inventory (DSSI) has been purported to be a reliable, systematic categorical measure to assess the patients with schizophrenia according to the degree of illness. However, further cross-validations using other clinical measures and diverse samples from other cultures have not been advanced recently. We aimed to examine the validity of the DSSI hierarchical class model using both Korean non-patient and patient (schizophrenia and depression) groups. METHOD: The hypothesis of inclusive, non-reflexive relationships among the DSSI classes was tested. The power of DSSI to detect presence of symptoms was assessed via cross-validation with other clinical measures, and the differences between the clinical features among the DSSI classes were examined using the Minnesota Multiphasic Personality Inventory (MMPI). RESULTS: The high rate of model conformity (91.1%) across the samples and cross-validation with other criterion measures provided further support for the validity of DSSI. CONCLUSIONS: DSSI is a reliable self-report measure that can be applied to both patient and non-patients to assess the presence and severity of psychiatric illness. Future studies that include more diverse clinical groups are necessary to lend further support for its utility in clinical practice.

Intercultural differences in factor structure of the SWN-20 in patients with schizophrenia.

We examined the reliability and factor structure of the Korean version of the 20-item Subjective Well-being Under Neuroleptic Treatment Scale (SWN-20) with Korean patients of schizophrenia and drew comparisons with the factors of the original authors and of comparable studies from Greece and Turkey to uncover evidences of possible cultural differences in the conceptualization of subjective well-being. The SWN-20 was found to be reliable and the factors seemed to reflect the emphasis often found in Asia on the wholeness of mind and body, and of self, others, and surroundings. Nonetheless, some crucial commonalities with other studies regarding the first primary factor suggested that a measure of well-being that is relatively consistent across cultures may be derived.

Intelligence, temperament, and personality are related to over- or under-reporting of affective symptoms by patients with euthymic mood disorder.

BACKGROUND: Many patients with mood disorders report subjective indicators of depression that are inconsistent with clinicians' objective ratings. This study used the self-report Beck Depressive Inventory (BDI) and the observer-rated Hamilton Depression Rating Scale (HAMD) to evaluate the extent to which temperament, personality traits, and clinical characteristics accounted for discrepancies between self-reports and clinician ratings of depressive symptoms in patients experiencing the euthymic period of a mood disorder. METHOD: The sample consisted of 100 individuals with bipolar disorder (n=72) or major depressive disorder (n=28). The HAMD and Young Mania Rating Scale were administered, and participants completed the BDI and Barratt Impulsivity Scale. Intelligence was assessed with the Korean Wechsler Adult Intelligence Scale. Patients completed the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire and the NEO-Five-Factor Inventory. RESULTS: The BDI and HAMD were significantly but modestly correlated with each other (r=0.319, p<0.001). Lower intelligence and a less conscientious personality were independent contributors to differences between Z-scores for the BDI and the HAMD. Higher impulsivity and a more anxious temperament were also observed in the group that self-reported more symptoms than were noted by clinicians. LIMITATIONS: Generalizability of results can be limited in ethnic difference. CONCLUSIONS: Subjective and objective assessments of the depressive symptoms of patients with mood disorders in a euthymic mood state are frequently discordant. Clinicians should consider the subjective aspects of depressive symptoms along with objective information about the influence of intelligence and personality on patients' self-reports.

Exploration of the associations between neurocognitive function and neuroleptics side effects.

The etiology of side effects of antipsychotic medications can be conceptualized as involving both specific pharmacological actions of a drug and any mental and physical states attributed by the patient. Both factors are likely to be linked with neurocognitive functioning which may largely affect the subjective experience of side effects in patients with schizophrenia. In this study, we examined whether baseline neurocognitive functions, such as IQ, attention, executive functioning, and short-term memory, are associated with baseline and 6-month follow-up measures of self-reported Liverpool University Neuroleptics Side Effects Scale (LUNSERS) and clinician-rated Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS). At the baseline, anxiety and depression were significantly associated with LUNSERS red herring (RH) and total side effects (SE) but not with DIEPSS. There was no association between LUNSERS and DIEPSS. Controlling for anxiety and depression, IQ was significantly correlated with DIEPSS, while choice reaction time (CRT) and stop signal task (SST) direction errors correlated with RH, and intra-extradimensional set-shifting (IED) total errors and pre-extradimensional set-shifting (pre-EDs) errors correlated with SE. The baseline SST direction errors further correlated significantly with RH and SE and DIEPSS total score of 6-month follow-up, and CRT mean and SD correct latency also correlated with DIEPSS. The correlations between the 6-month changes (Δ) in the same side effects measures and baseline neurocognitive measures were also significant, except that between RH and SST direction errors. Such evidences supported association between both self-rated and clinician-rated side effects and selective impairments in attention and executive functioning.

Impairments in executive functioning in patients with remitted and non-remitted schizophrenia.

OBJECTIVE: Although deficits in executive functioning are prominent in schizophrenia, some patients in remission have shown significantly higher levels of neurocognitive functioning than patients not in remission. However, no consensus on the relationship between neurocognitive functioning and the severity of symptoms has been reached. Additionally, previous studies have mainly examined the primary symptom domains of schizophrenia without considering the influence of anxiety symptoms, which are likely to influence neuropsychological performance. The aim of the present study was to compare the executive functioning of normal controls and with that of patients with schizophrenia in acute and remitted states. We further examined associations between impaired executive functioning in patients and anxiety levels. METHODS: Using a battery of tests assessing executive functioning including subtests of the Cambridge Neuropsychological Automated Test Battery (CANTAB) and the short form of the Korean Wechsler Adult Intelligence Scale (K-WAIS), we assessed 54 patients with schizophrenia and 33 normal controls. RESULTS: Our results showed that patients with non-remitted schizophrenia obtained significantly lower estimated IQ scores than did normal controls. They also exhibited longer reaction times on the Choice Reaction Time (CRT) test and the Stop Signal Test (SST) subtests of CANTAB and a greater number of total errors and errors that occurred before the extradimensional stage (i.e., pre-ED errors) on the Intradimensional/Extradimensional Shift (IED) subtest of CANTAB. Furthermore, those with schizophrenia in acute states showed significantly slower stop signal reaction times (SSRT) on the SST than did those with remitted schizophrenia and healthy controls. Finally, differences in the pre-ED errors and total adjusted errors on the IED became insignificant when scores on the Beck Anxiety Inventory (BAI) were entered as the covariate, whereas other significant differences remained when these scores were entered. CONCLUSION: Differences in executive functioning exist between patients with schizophrenia and healthy controls; these differences can be largely attributed to the relatively poor performance of patients in an active state.

The effects of psychopathology on subjective experience of side effects of antipsychotics in patients with schizophrenia.

This study was conducted to delineate the relationship between self-reported side effects and psychopathology in schizophrenia patients. Patients with schizophrenia completed the Liverpool University Neuroleptic Side Effects Rating Scale for subjective side effects and were evaluated with the Positive and Negative Syndrome Scale for their psychopathology. Based on a series of multiple linear regression analyses, we derived a model accounting for the relationships among the specific domains of psychopathology and red herring (RH) items of the Liverpool University Neuroleptic Side Effects Rating Scale in predicting subjective side effects. The model with anxiety/depressive symptoms and RH serving as mediators between positive symptoms and side effects was found to show good fit. Positive symptoms caused mostly anxiety symptoms and tendency to report RH items, whereby resulting in over-generalized reporting of subjective side effects. However, a large proportion of variance of side effects was explained by RH, which was only partially explained by positive symptoms alone. Therefore, patients with severe levels of positive and anxiety/depressive symptoms may be prone to nocebo-like effects of antipsychotics. Studies that include acute stage patients presenting severe levels of these symptoms should not rely only on the subjective report of side effects but also apply objective measures.

Clinician-rated functioning and patient-rated quality of life in schizophrenia: implications of their correspondence for psychopathology and side effects.

OBJECTIVE: Past studies have found inconsistent associations between subjective and objective measures of quality of life (QOL) in schizophrenia. We hypothesized that this may be due to heterogeneity in the demographic and/or clinical variables inherent in the samples and we investigated this possibility. METHODS: We stratified the patients according to a descriptive measure of correspondence between self-reported QOL and clinician-rated functioning. We then examined whether heterogeneous patterns existed among the subgroups in terms of demographic variables, symptom severity, associations between self-reported and clinician-rated psychopathology and associations between side effects, QOL and functioning. RESULTS: The subgroups significantly differed with respect to clinician-rated positive symptoms (F=3.075, p<.05), subjective symptoms (somatization, F=5.768, p<.01; obsessive-compulsive, F=3.885, p<.05; interpersonal sensitivity, F=8.278, p<.001; depression, F=9.368, p<.001; anxiety, F=6.909, p<.01; hostility, F=7.787, p<.01; phobic anxiety, F=9.551, p<.001; paranoia, F=5.304, p<.01; psychoticism, F=5.071, p<.01) and in- and outpatient ratio (Chi(2)=11.58, p<.01). Only the subgroup with relatively good correspondence between clinician-rated functioning and self-reported QOL showed significant low to moderate associations between the aforementioned measures and side effects. In addition, they showed similar levels of significant associations between the positive and subjective symptoms. In contrast, other discordant subgroups lacked overall associations between side effects, functioning and QOL as well as between subjective and objective measures of psychopathology. CONCLUSION: Low to moderate levels of correspondence between subjective QOL and objective functioning were partly supportive of the independence of the constructs. Insight is likely to be a mediating variable of the correspondence between self-report and clinician-rated measures and should be considered in studies using self-report measures.

Causal model of insight and psychopathology based on the PANSS factors: 1-year cross-sectional and longitudinal revalidation.

This study presents results of a 1-year follow-up investigation of the causal model of insight in schizophrenia using a subsample of acute patients starting or switching to amisulpride included in an earlier study. Our causal model of insight based on the Positive and Negative Syndrome Scale factors, with the positive, negative, and autistic preoccupation factors designated as the primary predictors, and the activation factor as a mediating variable of insight, was examined for fitness at the stabilized stage (8 week) and at the chronic stage (1 year) using the structural equation modeling method. Results showed that the intercorrelations among the factors and regression coefficients toward insight changed in their magnitudes, but the validity of our hypothesized model of insight was still confirmed for both the stages with nearly perfect goodness-of-fitness indices. The fitness of the model was also confirmed for the longitudinal changes in the scores of insight and psychopathology. An alternative model, which included the anxiety/depressive factor as a second mediating variable between insight and the positive and negative factors, was also found to be valid for both the stages. A post-hoc causal model with anxiety/depressive factor showed tentative evidence favoring anxiety/depressive variable predicting insight than the other way around.